川芎嗪及参麦注射液治疗缺血性心脏病心力衰竭50例

目的观察川芎嗪注射液联合参麦注射液治疗缺血性心脏病心力衰竭的近期疗效。方法100例缺血性心脏病心力衰竭病人按数字表法随机分为两组。对照组（50例）采用常规治疗，如血管紧张素转换酶抑制剂（ACEI）、洋地黄制剂、利尿剂、血管扩张剂等；治疗组（50例）应用川芎嗪注射液200mg联合参麦注射液50mL静脉输注，均每日1次；除不用洋地黄制剂、消心痛、硝酸甘油等扩血管药物外，其余治疗同对照组。两组均以10d为1个疗程，连用2个疗程。观察用药前后心率（HR）、心排血量（CO）、左室射血分数（LVEF）和左室舒张末期压力（LVEDP）等心功能参数及心功能分级、临床症状和体征的变化，并观察两组药物不良反应等。结果治疗组临床疗效明显改善，治疗组总有效率达92．0％，对照组为72．0％（P〈0．01）；两组治疗后LVEF、LVEDP均明显改善，治疗组药物不良反应和毒性作用发生率低于对照组。结论川芎嗪注射液联合参麦注射液治疗缺血性心脏病心力衰竭近期疗效显著，且无明显不良反应。     

生脉注射液联合黄芪注射液治疗慢性心力衰竭疗效观察

目的观察生脉注射液联合黄芪注射液治疗慢性心力衰竭的疗效。方法将58例心力衰竭患者随机分为两组。对照组28例,采用常规治疗;治疗组30例,在常规治疗基础上加用生脉注射液与黄芪注射液。结果治疗组总有效率93．3％,对照组总有效率75．0％,治疗组优于对照组（P〈0．01）。结论生脉注射液联合黄芪注射液治疗慢性心力衰竭优于常规治疗。     

倍他乐克治疗顽固性心力衰竭疗效观察

目的观察β受体阻滞剂（倍他乐克）对顽固性心力衰竭的临床疗效。方法将顽固性心力衰竭患者107例随机分为具有可比性的治疗组和对照组，在所有病例均给予强心、利尿、扩血管等常规治疗基础上，治疗组再加用倍他乐克，自12．5mg／d开始，第2周加至25mg／d，后逐渐增加至有效剂量或达到50—75mtg／d。服药6周，观察心率、血压、心电图、肝肾功能、左室舒张末期内径（LVDD）及左室射血分数（EF）的变化，并按NYHA做临床心功能分级评价。结果治疗组较对照组心功能各项指标均明显好转。结论在常规强心、利尿、扩血管治疗顽固性心衰的基础上，加用倍他乐克，对改善心力衰竭预后具有良好疗效。     

疏血通注射液联合地高辛治疗慢性肺源性心脏病心力衰竭46例

目的 观察疏血通注射液联合小剂量地高辛治疗慢性肺源性心脏病心力衰竭的疗效.方法 将92例慢性肺源性心脏病心力衰竭患者随机分为治疗组(46例)和对照组(46例).治疗组在常规治疗的基础上,予疏血通注射液6 mL联合口服地高辛0.125 mg/d;对照组在常规治疗基础上,口服地高辛0.25 mg/d.观察两组治疗前后疗效及动脉血气分析、血液流变学指标等.结果 治疗组临床疗效总有效率95.65%,对照组80.43%,两组疗效比较,差异有统计学意义(P<0.05).治疗组治疗前后血气分析、血液流变学比较亦有统计学意义(P<0.05).结论 疏血通注射液联合小剂量地高辛治疗慢性肺心病心力衰竭疗效确切.     

卡托普利联合美托洛尔治疗慢性心力衰竭76例

目的观察卡托普利联合美托洛尔（倍他乐克）治疗慢性心力衰竭的临床疗效。方法将76例慢性心力衰竭病人随机分为两组，对照组常规强心、利尿、扩血管，治疗组加用卡托普利25mg，每日两次，倍他乐克12．5mg～25．0mg，每日两次，疗程12周，观察病人临床症状、体征、再住院率、不良反应、心脏超声的变化。结果治疗组总有效率为95.0％，明显优于对照组的77．8％（P〈0.05）。治疗组治疗后心功能明显改善，左室射血分数增加、E／A值增高，左室容积变小，与治疗前及对照组治疗后均有统计学意义（P〈0．05），再住院率低，无明显不良反应。结论卡托普利联合倍他乐克治疗慢性心力衰竭安全有效，可改善病人预后。     

红花黄色素注射液治疗AECOPD合并慢性肺源性心脏病患者疗效观察

目的观察红花黄色素注射液治疗AECOPD合并慢性肺源性心脏病患者的疗效。方法选择本院确诊为AECOPD合并慢性肺源性心脏病患者69例,随机分为治疗组35例,在常规西药治疗基础上加用红花黄色素注射液150 mg静脉滴注,1次/d,共14 d。对照组34例采用西药基础常规治疗,用药前后对临床症状改善,血气指标,血液流变学指标,肺通气功能及心功能NT-proBNP指标进行对比观察。结果治疗组患者较对照组,治疗前后临床症状改善,血流变指标改善,肺功能FEV1、FEV1/FVC×100%、FEV1%,心功能NT-proBNP相关实验室指标均有明显改善(P0.05)。结论中西医结合在AECOPD合并慢性肺源性心脏病常规治疗基础上加用红花黄色素注射液对患者临床症状改善,血液粘稠度,血液流变学,肺功能及心功能改善明显,临床疗效确切。     

促肝细胞生长素联合苦黄治疗重型肝炎32例

目的观察促肝细胞生长素（PHGF）联合苦黄对重型肝炎的治疗效果．方法62例重型肝炎，随机分为两组，治疗组32例，对照组30例．两组均采用甘利欣、肝得健、支链氨基酸、FDP、血制品、维持水电解质平衡等综合治疗措施．治疗组加用PHGF120mg～200mg加入5％葡萄糖250mL中静滴，1次／d，苦黄注射液30mL加入5％葡萄糖250mL中静滴，1～2次／d，疗程20d～30d，部分病例30d以上．结果死亡率比较：治疗组25％，对照组43．33％；血清胆红素（SB）下降所需时间比较：降至171μmol／L所需时间（d），治疗组11．24±3．38，对照组19．28±3．40（P＜0．05），降至17．1μmol／L所需时间（d）治疗组：21．26±4．24，对照组33．16±4．28（P＜0．05）；两组患者主要并发症比较，感染，治疗组6例，对照组13例（P＜0．05），出血，治疗组5例，对照组11例（P＜0．05），肝性脑病，治疗组5例，对照组12例（P＜0．05），肝肾综合征，治疗组4例，对照组9例（P＜0．05）．结论PHGF联合苦黄能促进肝细胞再生，治疗重型肝炎能有效地缓解症状、防止并发症、降低死亡率效果较满意     

老年甲状腺功能亢进性心脏病临床特点及治疗

目的探讨老年甲状腺功能亢进性心脏病临床特点，总结经验，降低误诊率。方法对67例老年甲状腺功能亢进性心脏病的临床资料进行分析。结果心律失常27例(70．9％)，心衰4例(12．9％)，误诊率为35．8％。结论老年甲状腺功能亢进症(甲亢)起病隐匿，表现出较高的误诊率。对于以心脏病为首发症状的病例，采用早期、联合治疗可取得满意的治疗效果。     

不稳定型心绞痛倍他乐克静脉注射加口服治疗的疗效

目的：观察不稳定型心绞痛早期倍他乐克静脉注射加口服的疗效。方法：不稳定型心绞痛患者在早期常规治疗的同时立即注射倍他乐克5mg．间隔2min再注射1次．共3次。注射完毕15min后在第一个24b内，口服倍他乐克50mg．1／6h．然后口服100mg／d。对照组在常规治疗的同时口服倍他乐克50mg／12h。结果：静脉注射倍他乐克组心绞痛缓解率达94．6％．对照组为68．3％。结论：早期足量静脉注射倍他乐克治疗不稳定型心绞痛疗效确切，值得推广。     

低分子肝素钠联合硝酸甘油治疗肺心病合并冠心病心衰疗效观察

目的观察低分子肝素钠联合硝酸甘油治疗肺心病合并冠心病心衰临床转归和心功能改善情况。方法选择慢性肺心病合并冠心病心力衰竭患者80例，随机分为对照组（40例）及治疗组（40例）。对照组给予吸氧、抗感染、祛痰、平喘、扩血管、利尿等常规治疗。治疗组在常规治疗基础上加用低分子肝素钠80IU／kg，iH qd，硝酸甘油20mg＋5％GS 250ml ivgtt qd，10—25gttg／min，疗程7～10天。结果和对照组相比较，治疗组咳痰喘紫绀水肿症状明显减轻，心功能有明显好转（好转率92．5％），对照组好转率67．5％（P〈0．05）。结论慢性肺源性心脏病合并冠心病心力衰竭患者应用低分子肝素钠并硝酸甘油治疗，可明显减轻临床症状和改善心功能（NYHA心功能分级标准）。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

以肥厚性硬脑膜炎为主要表现的肉芽肿性多血管炎临床病例分析

目的探讨肉芽肿性多血管炎(GPA)继发肥厚性硬脑膜炎(HCP)的临床特点。方法回顾性分析北京协和医院2004—2018年收治的GPA继发HCP病例资料的特点。结果①GPA患者315例,19例继发HCP,占6.0%;②男性12例,女性7例;年龄19~64岁,中位年龄57岁。③神经系统表现:19例均有头痛,16例颅神经受累。受累部位:额部8例,颞部8例,颅底8例(鞍旁4例,其中海绵窦3例,眶尖2例),小脑幕6例,大脑镰2例,顶部1例,枕部1例,1例合并硬脊膜炎。④系统表现:发热10例,体质量下降8例,肺部受累4例,肾脏受累3例,16例鼻窦炎,10例中耳炎,16例局限型GPA。⑤15例ANCA抗体阳性,8例蛋白酶3(PR3)-ANCA阳性,6例髓过氧化物酶(MPO)-ANCA阳性。⑥16例行腰椎穿刺检查:脑脊液压力9例升高、5例正常、2例降低;脑脊液蛋白升高10例。⑦15例(78.9%)伯明翰系统性血管炎评分(BVAS)>15分。⑧19例均使用糖皮质激素、免疫抑制剂治疗,其中12例行甲泼尼龙冲击治疗,12例鞘内注射地塞米松(或+甲氨蝶呤),19例病情均缓解。结论HCP是GPA少见且严重的表现,主要表现为颅高压和颅神经受累,多见于局限型GPA患者,常伴有全身疾病的活动,需积极治疗。